1000 多例静脉曲张胶水消融术的经验:如何操作

О. Shirinbek
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摘要

氰基丙烯酸酯粘合剂闭合术(CAC)是目前治疗无功能隐静脉的主要非热消融方法之一。该方法的高效性和安全性得到了国际临床实践指南和实际应用的支持。与热消融术相比,CAC 在以下方面具有优势:术后疼痛和瘀伤少、手术时间短、术后恢复快、患者舒适度和满意度高以及避免术后压迫。本刊物根据莫斯科 "SM-Clinic "静脉中心 5 年(2019-2023 年)的经验,总结了胶水消融术的实用技巧和窍门。其中提出了首选使用 CAC 的指征,如疼痛阈值低;有术后压迫禁忌症(或不愿接受术后压迫);合并症多且体质脆弱的患者;合并病态肥胖;存在隐静脉轴向回流;需要同时消融多条闭锁的躯干静脉;膝下隐静脉闭锁,包括复发性静脉曲张;大面积脂肪性皮肤硬化和/或静脉性腿部溃疡;患者的艾滋病毒和病毒性肝炎呈阳性。本文介绍了胶水消融术的逐步介入方案,包括该手术的改良方案。根据目前的数据,讨论了 CAC 的近期和远期疗效。还特别关注了 CAC 术后的不良反应以及预防不良反应的技术问题。尽管 CAC 具有很高的疗效和安全性,但目前采用和广泛使用 CAC 的限制因素是成本问题和缺乏报销。
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From the experience of more than 1000 glue ablation procedures for varicose veins: how to do it
Cyanoacrylate adhesive closure (CAC) is currently one of the main non-thermal ablation modalities of incompetent saphenous veins. High efficacy and safety of the method is supported by international clinical practice guidelines as well as the real-world practice. In contrast to thermal ablation, CAC is advantageous in terms of low periprocedural pain and bruising, fast procedure time and postprocedural recovery, high patient comfort and satisfaction rates as well as avoidance of postprocedural compression. This publication summarises the practical tips and tricks of glue ablation procedure based on 5-year experience (2019–2023) at the “SM-Clinic” Phlebology Centre, Moscow. Indications for the preferred use of CAC are formulated, such as: low pain threshold; contraindications (or unwillingness) to postprocedural compression; extensive comorbidity and fragile patients; concomitant morbid obesity; the presence of axial reflux along the saphenous veins; the need for simultaneous ablation of several incompetent truncal veins; below-the-knee incompetence of saphenous veins, including recurrent varicose veins; extensive lipodermatosclerosis and/or venous leg ulcer; patient’s HIV and viral hepatitis positive status. A step-by-step interventional protocol of glue ablation is described, including the modified protocols of the procedure. The immediate and long-term outcomes of the CAC according to current data are discussed. Special attention is paid to adverse events following CAC, as well as technical aspects of their prevention. Despite high efficacy and safety profile, today’s limitations for adoption and wider use of CAC are cost issues and lack of reimbursement.
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